Collaborative Specialty Care for Gulf War Illness

海湾战争退伍军人(GWVS)应该得到的护理与他们所做的护理之间存在着质量鸿沟 收到。我们的数据显示，70%患有海湾战争病(GWI)的GWV没有接受治疗建议 对于他们的GWI和78%的人对他们的护理不是很满意。缩小这种质量鸿沟至关重要。退伍军人事务部 国防部已经投资了数亿美元来开发新的治疗方法，包括第二大 GWVS的临床试验发现，健康指导和解决问题的治疗方法都能减少残疾 第一次世界大战期间。如果没有有效的医疗保健模式来实施这些治疗，GWVS将不会受益。在 当前的护理模式，GWVS通过退伍军人管理局的初级保健患者协调护理团队在当地接受护理 (协定)。退伍军人事务部战争相关疾病和伤害研究中心(WRIISC)通过以下方式支持当前的护理模式 通过国家教育增加当地对管理全球变暖所需技能和治疗的了解 关于疑难案件的努力和电子咨询(电子咨询)。WRIISC和其他利益相关者 目前质疑提高当地对GWI技能和治疗的知识是否足以解决 质量鸿沟，或者如果GWI太复杂，如果没有额外的支持就无法在初级保健中治疗 GWI的专家。GWI的一个潜在有用的护理模式是协作式专科护理，其中专家 与PACTS合作，协同治疗患者。当地协议是团队与专家的领头羊 向患者提供一些直接护理(通过远程医疗)，并与PACT就其他 护理的各个方面。协作性专科护理对其他复杂情况(如抑郁症)也有效 有40多项研究记录了它的疗效。这项建议的目标是进行混合类型1的随机化 GWVS与GWI的有效性/实施试验(n=220)。我们的主要目标是确定 与电子会诊相比，远程会诊的有效性。在Tele-CSC，我们的专业提供商团队将提供 对GWVS进行健康指导和问题解决治疗，并推荐每月签订合同 镇痛药的优化。在电子咨询中，专业提供商团队将提供一次性推荐 约定GWV在当地接受健康指导、解决问题的治疗和止痛药 优化。我们的次要目标是了解执行结果。这些信息将被用于 指导未来的随机(由VISN)多站点实施研究。在整个过程中，一个咨询委员会 将召集业务合作伙伴，以确保研究结果能够直接和立即 改善护理。确定最佳护理模式以将研究转化为GWVS的实践是一项 退伍军人事务部海湾战争战略计划的关键目标和本申请的具体目标。

There is a quality chasm between the care Gulf War Veterans (GWVs) should receive and the care they do receive. Our data show 70% of GWVs with Gulf War Illness (GWI) do not receive treatment recommendations for their GWI and 78% are NOT very satisfied with their care. Reducing this quality chasm is essential. The VA and DoD have invested hundreds of millions of dollars to develop new treatments, including the second largest clinical trial for GWVs which is finding health coaching and problem-solving treatment both reduce the disability of GWI. Without effective models of healthcare to implement these treatments, GWVs will not benefit. In the current model of care, GWVs receive care locally through VA’s primary care patient aligned care teams (PACTs). The VA War Related Illness and Injury Study Center (WRIISC) supports the current model of care by increasing local knowledge of the skills and treatments needed to manage GWI through national education efforts and electronic consultation (e-consultation) on difficult cases. The WRIISC and other stakeholders are currently questioning whether improving local knowledge of skills and treatments for GWI is enough to address the quality chasm, or if GWI is too complex to be treated in primary care without additional support from specialists in GWI. A potentially useful model of care for GWI is collaborative specialty care where specialists work with PACTs to synergistically treat patients. The local PACT is the lead of the team with the specialist providing some direct care to the patient (through tele-health) and also consulting with the PACT about other aspects of care. Collaborative specialty care is effective for other complex conditions (e.g., depression) with over 40 studies documenting its efficacy. The goal of this proposal is to conduct a hybrid type 1 randomized effectiveness/implementation trial for GWVs with GWI (n=220). Our primary aim is to determine the effectiveness of tele-CSC as compared to e-consultation. In tele-CSC, our specialty provider team will deliver health coaching and problem-solving treatment to GWVs and recommend the PACT make monthly optimization of analgesics. In e-consultation the specialty provider team will make a onetime recommendation to the PACT that the GWV locally receive health coaching and problem-solving treatment and analgesic optimization. Our secondary aim is to understand implementation outcomes. This information will be used to guide a future randomized (by VISN) multi-site implementation study. Throughout, an advisory committee of operations partners will be convened to ensure that the results of the study are able to directly and immediately improve care. Determining the best model of care to translate research into practice for GWVs with GWI is a key goal of the VA Gulf War Strategic Plan and a specific aim of this Request for Applications.